The role of fascia in manual therapists’ diagnosis and treatment – A critical literature review

Item

Title
The role of fascia in manual therapists’ diagnosis and treatment – A critical literature review
Author(s)
Dussol, T
Abstract
Introduction: The interest about fascia is growing. Some manual therapists claim to be able to specifically palpate it, draw a diagnosis and bring change in the tissues. The aim of this review is to analyse some of those claims in the light of current evidence Method: The aim being to compare evidence-based information with manual therapists' claims, not only peer-reviewed evidence-based articles have been used, but also specialised books written by manual therapists. Discussion: A number of Extracellular Matrix (ECM) patho'-physiological conditions can be linked to tissue history, dehydration or postural habit (plasticity). Immobilisation, ageing and pain-related fears can lead to a decrease in physical activity. Tissue immobilisation and hypoxia trigger tissue adhesion, fibrosis and TrP formation. These can further increase tissue ischemia and toxicity, by impeding on the biomechanical properties of fascia, cellular metabolite diffusion, fluid dynamics, immunity, proprioception, piezoelectric, streaming potential effects, myofascial and visceral movements. Manual therapists should combine palpation with provocation tests to improve the reliability of their diagnosis. The poor inter-examiner reliability may be due to a lack of consistency in the processes used to identify anatomical landmarks, rather than discrepancies in palpation. Tissue texture change following treatment seem to be a short-term effect, but gel-to-sol and return-to-gel transitions allow the release of toxins and cellular waste products _trapped' in the tissue. General movement and compression loading treatments enable collagen fibres to realign according to the direction of pull, thereby improving ground substance, water content and decreasing adhesions formation. It appears to be easier for manual therapists to prevent the formation of adhesions rather than breaking them down once they have formed. Myofascial techniques can bring short term pain relief, but more experiments need to be carried out to look into their long term effects. HVTs seem to effectively decrease pain perception when applied to the low back, even in cases of Prolapsed Inter-Vertebral Disc (PIVD). For the neck area, the association of specific exercises with HVT treatments seems to be more effective. In the long term, manual therapists can assist postural changes by affecting the patient's environment and habits: by prescribing exercises to reinforce hypotonic areas and slow stretches to address the hypertonic myofascia with or without trigger points (TrP). Craniosacral techniques appear to create change in subjects, although further investigations in this field are needed. Some evidence suggests that colicky symptoms in babies may be effectively treated using cranial techniques and furthermore, it is suggested that babies who are pre-disposed to such symptoms couldbe identified early on, on the basis of some cranial clinical findings. Controversial as it may be, it also appears that compression of the 4th Ventricle (CV4) and its associated effects may contribute towards improving sleep and relaxation. Conclusion: There are no clear answers as to what manual therapists can or cannot achieve: many experiments were performed with small samples size or consisted of
single case studies, therefore making their conclusions impossible to extrapolate to
presented at
European School of Osteopathy
Date Accepted
2011
Date Submitted
22.1.2013 16:23:35
Type
osteo_thesis
Language
English
Submitted by:
62
Pub-Identifier
15266
Inst-Identifier
1229
Keywords
Fascia; Manual therapy; Diagnosis; Treatment
Recommended
0
Item sets
Thesis

Dussol, T, “The role of fascia in manual therapists’ diagnosis and treatment – A critical literature review”, Osteopathic Research Web, accessed May 2, 2024, https://www.osteopathicresearch.com/s/orw/item/799